These tools can be used to assess a patient’s outcomes before and after treatment, providing a risk-adjusted direct measurement of PT’s impact. As providers often struggle with manual administration of PROM questionnaires, an innovative PT alternative payment program should support more effective digital means of ensuring high PROMs collection rates. This should generate interest from a percentage of participating providers, as hospitals and health plans can use PROMs data to apply for various national quality accreditations. PROMs can also help providers track minimal clinically important differences, or changes in a clinical intervention that are meaningful for the patient, which can help providers drive best practices.

A well-designed digital care management platform parcels out PROMs over time, aligned with the patient’s treatment progression, to encourage compliance and combat form fatigue. Similarly, an intelligent utilization management (UM) platform can enable the routine collection of patient-reported outcomes at regular intervals throughout the patient’s care, such as before PT begins, a few months into the therapy, and when the patient moves on to subsequent treatment options. Along with collecting online questionnaires, an intelligent utilization management platform can also use machine learning to extract pertinent outcomes data from the patient’s clinical notes, providing an additional level of reporting.


To conclude, PT represents a major new opportunity for payment innovation. Relying on claims-based data to determine initial cost benchmarks and quality standards allows for a shorter implementation time and faster analytics development, without saddling either providers or payers with the burden of additional data collection.

After the initial model generates proof points, payers can build data collection mechanisms to amass digital pre-and post-therapy outcomes data, leading to the development of PROM-based effectiveness measures. In time, these more comprehensive quality standards can help to drive better outcomes at a lower cost for the large percentage of the population receiving conservative physical therapy treatment.


About the author: Nan Tracy Zheng, Ph.D., serves as vice president of clinical programs and quality analytics at Cohere Health, a utilization management technology company that aligns patients, physicians, and health plans on evidence-based treatment plans at the point of diagnosis.

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